tbuckley/cabot-search huggingface dataset:
Abstract P648: Flattening the Curve: A Behavioural Economics Approach to Increase Activity in Summer Months
Authors: Isaak D Fast, Shamsia Sobhan, Jon McGavock
Journal: Circulation (2023)

Objective: The purpose of this study was to determine if the behavioural economics principle “Fresh Start Effect” was evident within population-based patterns of cycling-specific active transportation (AT). The primary hypothesis was that cycling traffic along AT trails would not exhibit a fresh start effect, compared to cycling traffic along leisure trails. Design and Methods: We triangulated data from three data sources (n=3 million individual data counts) to test this hypothesis. First, the main outcome measure, cycling traffic was captured during summer months (May to September) from 2014 to 2019 with electromagnetic EcoCounters embedded in 5 paved multi-use trails in Winnipeg, Canada. Trails were categorized as AT (bi-modal peaks in traffic in the morning and afternoon) or leisure based on daily patterns of cycling traffic (single peaks of traffic in the afternoon). To confirm trends in AT-based cycling, we used daily bicycle parking data from 2012 to 2019 provided by one of the cities largest companies. To replicate the leisure-based Fresh Start effect trend we used data for fitness centre visits from the largest University in the city between 2017 and 2019. To estimate the weekly trends in occupational attendance we captured sales data from a local coffee shop from 2013 to 2019. Generalized linear mixed effects models compared counts between Mondays and other weekdays for all 4 datasets. Results: Cycling traffic was ~22% lower on Fridays relative to Mondays for both AT trails (-89 counts; 95% CI: -33 to -145counts for AT trails vs -86 counts). Nearly identical trends were observed for leisure type multi-use trails (-86 counts; 95% CI: -38 to -135 counts for leisure trails). Daily rates of occupational bicycle parking (i.e. cycling to work) were 14% lower on Fridays compared the beginning of the week (-7 counts; 95% CI: -4 to -10 counts). Daily rates of fitness centre attendance (i.e. leisure physical activity) were 18% lower on Fridays relative to the beginning of the week (-519 counts; 95% CI: -408 to -630 counts). In contrast to cycling and fitness centre data, daily coffee sales increased 15% on Fridays relative to the beginning of the week, (+42.8 counts; 95% CI: +34.1 - +51.5) suggesting that declines in cycling and leisure physical activity were not related to fewer people working on Fridays. Conclusions: Population-based AT and leisure-based cycling patterns are sensitive to the Fresh Start Effect. These data provide data to guide targeted public health strategies to increase AT and leisure-based cycling in urban areas.
Abstract P539A: Advanced Chronic Kidney Disease Does Not Significantly Affect All-Cause Mortality and Rate of Hemodynamic Complications in Acute Pericarditis
Authors: Dennis Kumi, Edwin Gwira-Tamattey, Ufuk Vardar, Sadichhya Karki, Birju Patel
Journal: Circulation (2023)

Background: Advanced chronic kidney disease (advanced CKD) patients have several metabolic, immunologic, and hemodynamic derangements that can negatively impact the natural history of cardiac disease. Some efficacious treatments for acute pericarditis such as colchicine and NSAIDS may not be well tolerated by advanced CKD patients. Hypothesis: Advanced CKD may portend worse outcomes based on clinical severity and likely higher side effect of treatments among patients hospitalized with acute pericarditis. Method: A retrospective cohort study with data from the 2016 to 2018 combined National Inpatient Sample (NIS) database was employed. ICD-10 codes were used to sample all adult admissions for acute pericarditis who were dichotomized based on the presence of a secondary diagnosis of advanced CKD including CKD stage 4, stage 5 and dialysis dependent patients. Primary outcomes of study were Mortality rate, length of stay and total hospital charge. Secondary outcomes were cardiac tamponade, cardiogenic shock, pericardial window rate, supraventricular tachycardia (SVT), ventricular tachycardia (VT) and gastrointestinal (GI) bleeding rate. Multivariate linear and logistic regressions were used to adjust for confounders. Results: We identified a total of 36570 admissions for acute pericarditis and among these, 4139.99 representing 5.96% had associated advanced CKD diagnosis. These patients were averagely 5 years older (57.14 vs 52.35, adjusted difference of 4.80 years, 95%CI: 3.11 - 6.48, p-value &lt;0.001) and predominantly female (44.5% vs 39.12%, AOR 1.25, 95%CI: 1.02 - 1.52, p value: 0.029) compared to the counterpart cohort group. Details of study outcomes are summarized in table 1 below. Conclusion: Among patients hospitalized with acute pericarditis, the presence of advanced CKD as a secondary diagnosis was associated with increase length of stay and total charge but without statistical significance effect on odds of mortality and odds of relevant hemodynamic complications.
Abstract P630: Dietary Sodium Intake Increases the Risk of Developing Type 2 Diabetes Mellitus in the Million Veteran Program
Authors: Hasan Mahbub, Xuan-Mai Nguyen, Yanping Li, Rachel Ward, Frank Hu, Walter Willett, John M Gaziano, Luc Djousse on behalf of the VA Million Veteran Progra
Journal: Circulation (2023)

Background: Type 2 Diabetes Mellitus (T2DM) affects 10.5% of the US population (~34.2 million people). While previous studies have shown that high intake of sodium is associated with the worsening of the T2DM parameters, it is unclear whether dietary sodium intake is associated with incidence of T2DM. We prospectively examined the association of sodium and potassium intake and risk for T2DM among participants of the Million Veteran Program (MVP). Methods: Between 2011 to 2020, 379,852 participants from the MVP completed a semi-quantitative food frequency questionnaire (sFFQ). Incidence of T2DM was ascertained using ICD-9 code 258.xx from electronic health records. We used Cox proportional hazards model to calculate hazard ratio (HR) with 95% confidence intervals (CIs) for T2DM adjusting for confounding factors. Results: Among the 234,721 veterans analyzed, mean age was 65 years (age range 19-106), 91% were male, and 88% were Caucasian. The observed energy-adjusted mean sodium intake was 1222 mg/day (1103 for females, 1234 for males) and potassium intake was 2596 mg/day (2534 for females, 2602 for males). During a mean follow-up of 4.4 years, 8,753 participants developed T2DM. After adjusting for confounding factors, a higher sodium intake was associated with 11% higher risk of T2DM (HR: 1.11, 95% CI: 1.04, 1.19, p-trend=0.0006); while a higher potassium intake was associated with a 6% lower risk of T2DM (HR: 0.94, 95% CI: 0.92, 0.97) (Figure). Conclusion: Higher intake of dietary sodium and lower intake of dietary potassium were each associated with a higher risk of developing T2DM among US veterans.
Abstract P404: The Virtual Home Clinic: Challenges and Solutions
Authors: Elaine M Urbina, Camilo Fernandez Alonso, Lydia A Bazzano, Jessica G Woo
Journal: Circulation (2023)

Longitudinal studies provide rich sources of data to explore early risk factors for future CV diseases. However, cohort participants often move away from their initial recruitment site. Therefore, we are assessing feasibility of mailing of devices to the home for collection of biometric data followed by an in-person assessment to validate the home devices. Participants (N=215) from the Bogalusa Heart Study, National Growth &amp; Health Study and the Princeton Lipid Research Study who were initially enrolled as children in the 1970s and 1980s were recruited. Devices sent to the home ( Table ) measure anthropometrics, BP, HR, heart rhythm, resting metabolic rate, O2 saturation, glucose, total cholesterol, physical activity, diet, sleep duration/quality, and arterial stiffness. Stool and saliva are also collected for microbiome, DNA and cotinine. General issues encountered include institutional firewall requiring permission to load apps on an iPAD, apps requiring wi-fi or an email, complicated instructions for participants, different processes for account setup, data retrieval, cleaning/disinfection, need to delete old data/resetting for each device, and differing exported data file formats requiring extensive programming to import into statistical software. This feasibility study will provide new opportunities to continue to follow our participants who have provided invaluable contributions to science for the last 40 years.
Abstract MP08: Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Cohort Study From UK Biobank
Authors: Mercedes Sotos-Prieto, Javier Maroto Rodriguez, Mario Delgado-Velandia, Aurora Perez-Cornago, Rosario Ortola, Fernando Rodriguez-Artalejo
Journal: Circulation (2023)

Background: There is strong evidence that the Mediterranean diet protects from cardiovascular disease (CVD); however, beyond diet, the Mediterranean lifestyle may have synergistic effects through the combination of other health behaviors, such as adequate rest or sociability. While most evidence on this lifestyle pattern comes from Mediterranean countries, little is known about the health effects of a Mediterranean lifestyle in non-Mediterranean populations. Our aim was to examine the association between a Mediterranean lifestyle index (MEDLIFE) and all-cause, (CVD), and cancer mortality in a British population. Methods: We used data from 110,799 individuals free of CVD or cancer, aged 40-69 years, from the UK Biobank cohort, who were followed from 2006-2010 to 2020. The Mediterranean lifestyle was assessed through the validated 26-item MEDLIFE index derived from the lifestyle questionnaire and from 2 or more Oxford WebQ Online 24-hour diet recalls. MEDLIFE comprised three blocks: a) Block 1 (13 items): Mediterranean food consumption, b) Block 2 (7 items): Mediterranean dietary habits, c) Block 3 (6 items): Physical activity, rest, social habits, and conviviality. Mortality was obtained from the death register records. Multivariable-adjusted Cox proportional-hazards regression models were used to analyse associations between MEDLIFE and all-cause, CVD, and cancer mortality. Results: After a mean 9.4-year follow-up, 4,247 deaths were identified. Higher adherence to the MEDLIFE index was associated with lower all-cause and cancer mortality in a dose-response manner. Compared to the first quartile of adherence to the MEDLIFE, the increasingly higher quartiles had a HR (95% CI) of 0.89 (0.81 -0.97), 0.81 (0.74-0.89) and 0.71 (0.65-0.78), p-trend &lt;0.001, for all-cause mortality; and 0.90 (0.80-1.01), 0.83 (0.74-0.93) and 0.72 (0.64-0.82), p -trend &lt;0.001, for cancer mortality. All MEDLIFE blocks were independently associated with lower risk of all-cause and cancer death, and block 3 with lower CVD mortality. Conclusions: A Mediterranean lifestyle was associated to reduced all-cause and cancer-mortality in British middle-aged and older adults; this suggests that adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations is possible and can be part of a healthy lifestyle.
Abstract P535: Associations of Genetically Determined Favourable and Unfavourable Adiposity Across the Phenome
Authors: Marie-Joe Dib, Loukas Zagkos, Paul Elliott, Abbas Dehghan, Ioanna Tzoulaki
Journal: Circulation (2023)

Background: The large-scale investigation of the genetic architecture of favourable adiposity (FA) and unfavourable adiposity (UFA) may unravel mechanisms coupling higher adiposity and cardiometabolic comorbidities, and may in turn aid in the prevention, prediction and management of these diseases. Aims and Objectives: We aimed to interrogate FA and UFA in relation to a plethora of clinical outcomes, investigate their causality, and test whether a healthy lifestyle interacts with FA/UFA for the risk of disease. Materials and Methods: We performed a Mendelian randomisation-phenome-wide association study (MR-PheWAS) to identify health outcomes associated with FA and UFA. We first conducted a PheWAS of FA and UFA with 988 phenotypes in 426,295 UK Biobank individuals. Health outcomes passing false-discovery rate (FDR) correction for multiple testing were taken forward to MR analyses. SNP-outcome associations were extracted from external GWAS consortia data. Finally, we examined the association between FA/UFA tertiles of genetic risk and tertiles of lifestyle score and incident health outcomes using proportional hazards models. Results: Our two sample MR results suggest that a 1-SD higher genetically instrumented FA is associated with lower odds of type 2 diabetes (OR: 0.05, 95% CI: 0.02 to 0.11), hypertension (0.30, 0.18 to 0.50) and coronary atherosclerosis (0.25, 0.10 to 0.62), and with higher odds of ventral hernia (18.15, 4.22-77.97). Moreover, 1-SD higher genetically determined UFA was associated with increased odds of type 2 diabetes (5.30, 3.27-8.61), hypertension (2.40, 1.55-3.71), myocardial infarction (1.99, 1.49-2.65), cholelithiasis (2.92, 1.87-4.56), and atrial fibrillation (2.17, 1.28-3.69) at significance passing FDR q&lt;0.05. Sensitivity analyses were consistent with the main results. Our Cox regression model indicated that a favourable lifestyle is associated with a more pronounced risk reduction in cardiometabolic health outcomes and can have a more substantial impact on cardiometabolic and inflammatory conditions for individuals with either a high FA and a low UFA GRS profiles. Conclusions: Our findings offer novel insight into previously unreported effects of favourable and unfavourable adiposity, suggesting that a healthy lifestyle can benefit individuals with both favourable and unfavourable genetic risk scores. This highlights the importance of population-wide lifestyle approaches to address the problem of obesity and risk-stratifying the population according to favourable and unfavourable adiposity.
Abstract P661: Potential Determinants Are Associated With Thyroid Peroxidase Antibodies Titers in Men and Women Participants of the ELSA-Brasil Study
Authors: Vandrize Meneghini, William Tebar, Itamar S Santos, Carolina Janovsky, Paulo A Lotufo, Alessandra C Goulart, Isabela M Bensenor
Journal: Circulation (2023)

Introduction: Recently, TPOAb has been highlighted as an indicator of autoimmune diseases in general and low-grade inflammation. However, little is known about the distribution of TPOAb categories according to sociodemographic and lifestyle characteristics. Hypothesis: We assessed the hypothesis that potential determinants are associated with multiple categories of TPOAb in euthyroid individuals, according to sex. Methods: We analyzed the data of 4,977 males and 5,197 females (median age of 50 years-old), without thyroid diseases, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort study. Fasting serum TPOAb levels were determined and categorized as undetectable (≤ 5.00 IU/mL), low detectable (5.01-14.99 IU/mL), high detectable (15.00-33.99 IU/mL), and positive (34.00-600.00 IU/mL). Thyrotropin and potential determinants (age, natural log body mass index (lnBMI), self-reported race, education, smoking, and alcohol intake) were also assessed. Adjusted multinomial regression models were applied to determine odds ratio (OR) and 95% confidence intervals (CI), separately for males and females, using the undetectable TPOAb as reference category. Results: For males, multivariate analyses showed that higher lnBMI levels were associated with higher odds of having low detectable (OR=2.61, CI=1.13-5.99) and positive (OR=3.11, CI=1.03-9.42) TPOAb. White race and current smokers were associated with low detectable, high detectable, and positive TPOAb (ORs range from 2.05 to 4.58). Participants with higher education were less likely to present TPOAb low and high detectability and positivity, when compared to those with lower education (ORs range from 0.31 to 0.51). Moreover, those with intermediate education and heavy drinkers presented lower odds of TPOAb high detectability (OR=0.58, CI=0.36-0.93) TPOAb positivity (OR=0.52, CI=0.28-0.95), respectively. In the female group, White race and current smokers were associated with higher odds of having low detectable (OR race =2.27, CI=1.71-3.02; OR smoking =5.33, CI=2.32-12.24), high detectable (OR race =2.43, CI=1.78-3.31; OR smoking =11.15, CI=4.80-25.92) and positive (OR race =2.59, CI=1.85-3.63; OR smoking =5.97, CI=2.49-14.33) TPOAb, comparing to non-White race and those that never smoked, respectively. Furthermore, participants with higher and intermediate education, compared to lower education, and heavy drinkers compared to non-drinkers were less likely to present TPOAb detectability and positive (ORs range from 0.23 to 0.47). Age was not significantly associated with TPOAb (p&gt;0.05). Conclusions: In conclusion, self-reported race, education attainment, smoking status, and alcohol intake were determinants of TPOAb detectability and positivity for euthyroid men and women. Moreover, higher BMI was associated with low detectable and positive TPOAb only for the male sex.
Abstract P514: Evaluating the Concordance Between Trends in Prescription Volume and Online Interest for the Weight Loss Formulation of Semaglutide
Authors: Rishav Adhikari, Omar Dzaye, Michael J Blaha
Journal: Circulation (2023)

Introduction: Weight loss dosing of semaglutide (Wegovy™) is a preferred anti-obesity medication due to its efficacy, safety, and potential cardioprotective benefits. However, soon after FDA approval, supply shortages restricted availability and forced the manufacturer to suspend new initiations, despite large interest. We characterized trends in prescription volume of this drug since approval compared to other obesity medications and correlated it to online search interest. Methods: We derived monthly prescription dispensing and revenue data for all anti-obesity prescription medications from IQVIA’s National Prescription Audit. This audit captures 93% of outpatient prescription dispensing in the U.S. and projects to population-level data. We also retrieved online search data from Google Trends for Health for a variety of terms relevant to obesity treatment and drug generic/brand names. We analyzed data from May 2016 - April 2022 for visual and quantitative trends and assessed correlation between online searches and prescription volume with Spearman's correlation for non-parametric variables. Results: Prescriptions for Wegovy™ increased rapidly after entering the market in June 2021. It became the second most prescribed weight loss medication within 4 months, below phentermine and ahead of the weight loss dosing of liraglutide (Saxenda™). By December 2021, Wegovy™ comprised 10.7% of weight loss prescriptions. However, in subsequent months, prescriptions plateaued at ≈100,000/month (≈11% market share), coinciding with manufacturer reports of supply shortages. Cardiologists accounted for 0.7% of Wegovy™ use across the study. While the compounded monthly growth rate for prescriptions in the first 5 full months of drug availability was 34%, this slowed to 3% in the final 5 months of the study. Despite slowed growth, Wegovy™ comprised 59% of monthly pharmacy revenue for prescription weight loss drugs ($163 million) by April 2022. An abrupt spike in online searches for “Wegovy,” “semaglutide,” and “weight loss drug” coincided with FDA approval in June 2021, with “Wegovy” searches peaking at 195 queries per 10 million searches before falling to 85 by Sept. 2021. Following this initial peak and fall, Google searches for “Wegovy” rose exponentially, with a monthly increase of 20% in the final 5 months of the study. We observed a weaker correlation between online searches and prescriptions for Wegovy™ (Spearman’s correlation coefficient 0.65) compared with other cardiometabolic drugs which also had growing prescription volumes (0.79-0.99). Conclusions: As growth in Wegovy™ prescriptions decelerated, online searches continued to grow exponentially, even in the absence of manufacturer marketing. This contrast suggests that interest among clinicians and patients is likely outstripping drug availability, hampering the impending paradigm shift in treatment of obesity.
Abstract MP16: Status of Cardiovascular Health in US Immigrants Using the AHA’s Life’s Essential 8 Metrics: Prevalence Estimates and Social Determinants From the 2013-2018 National Health and Nutrition Examination Survey
Authors: Nour Makarem, Rahul Hosalli, Vanessa Dinh, Billy A Caceres, Amanda C McClain, Pricila Mullachery, Odayme Quesada
Journal: Circulation (2023)

Introduction: The US has the largest immigrant population globally, with a record high ~47 million foreign-born residents in 2022. Immigrants endure social and structural factors that may adversely influence their cardiovascular health (CVH). Hypothesis: Overall and individual metrics of CVH will vary by immigration status (US-born vs. foreign-born) and among foreign-born sub-populations. Methods: The analytic sample included 13,471 adults (19% foreign-born), ages 20-79 y (not pregnant or institutionalized) and free of CVD, from the 2013-2018 NHANES. We calculated the CVH score (range 0-100, low CVH: &lt;50) and component scores, consistent with AHA’s Life’s Essential 8 guidelines. T-tests were used to compare CVH scores by nativity and, among foreign-born individuals, by sex, ethnicity, years in the US, and citizenship. Survey weighted logistic models evaluated social determinants of health (SDOH) in relation to odds of having low CVH. Results: Compared to US-born adults, foreign-born adults had higher overall CVH, diet, nicotine exposure, BMI, and blood pressure scores, but lower physical activity, glucose, and cholesterol scores (p&lt;0.01); there were no differences in sleep health scores (Figure A). Among immigrants, those who were men, Hispanic, and living in the US ≥15y had lower CVH scores (p&lt;0.001); CVH scores did not differ by citizenship (Figure B-E). Scores for individual CVH metrics also varied across immigrant sub-populations. In logistic models, being male, 45+ y, Hispanic, food insecure, or having &lt; college education, depression, or ≥15y in the US was related to 57%-150% higher odds of having low CVH. Marital status, income, health insurance, citizenship, and home ownership were not related to CVH. Conclusions: While US immigrants have higher overall CVH compared to US-born persons, CVH status is complex and varies across immigrant sub-populations. Understanding immigration as a SDOH is essential for effective public health initiatives aimed at improving CVH in the heterogeneous US immigrant population.